Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T01:25:51.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Latent classes in diagnoses among psychiatric inpatients predicting mortality and imprisonment – a nationwide cohort study

Published online by Cambridge University Press:  23 March 2020

H.K. Carlsen ,
S. Steingrimsson ,
M.I. Sigurdsson ,
S. Sigfússon  and
A. Magnússon
H.K. Carlsen
Affiliation:
Mental Health Services, Landspitali–National University Hospital, Eiriksgata 5, 101Reykajvík, Iceland Faculty of medicine, University of Iceland, Vatnsmyrarvegur 16, 101Reykhavík, Iceland
S. Steingrimsson*
Affiliation:
Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Hoppets väg 13, Box 100, 40530Gothenburg, Sweden
M.I. Sigurdsson
Affiliation:
Mental Health Services, Landspitali–National University Hospital, Eiriksgata 5, 101Reykajvík, Iceland
S. Sigfússon
Affiliation:
Department of Psychiatry, Akureyri Hospital, Eyrarlandsvegi, 600Akureyri, Iceland
A. Magnússon
Affiliation:
Mental Health Services, Landspitali–National University Hospital, Eiriksgata 5, 101Reykajvík, Iceland
*
*Corresponding author. E-mail address:[email protected]
Get access

Abstract

Purpose

Identify risk factors of death or imprisonment within classes defined by demographic factors and diagnoses within one year of first psychiatric admission.

Methods

Nationwide data was obtained from hospital registers from psychiatric hospitals in Iceland 1983–2007. Mortality and cause of death as well as information about imprisonments during the study period, and discharge diagnoses for the first year after initial admission were obtained for each individual. Individuals aged 18 during the study period with at least one year of follow-up were included. Latent Class Analysis was used to identify groups with distinguishable risk of either being alive, dead or having been imprisoned at the end of follow-up.

Results

Among psychiatric patients, 4677 were included, average age was 27 years (range 18–43). Four latent classes were identified with different risks of adverse outcomes. Class B (16%), predominantly males with substance use disorder (SUD) diagnoses, had highly increased risk of imprisonment and death accounting for 85 and 34% of these outcomes, respectively. Class A (12%), all with alcohol use disorder, had similar mortality rate as the general population and no imprisonments. Class C (23%) were younger at first admission with some SUD and increased risk of mortality. Class D (46%) had increased mortality rate, SUDs were rare but depression common.

Conclusions

Risk of mortality and criminal trends among psychiatric inpatients can be described as distinct clusters of risk factors present at first admission to a psychiatric hospital. Treatment and interventions to reduce mortality and criminality should take these risk differences into account.

Keywords

Inpatient mental servicesMental illnessAffective disordersSurvivalImprisonment
Type
Original article
Information
European Psychiatry , Volume 39 , January 2017 , pp. 93 - 98
Copyright
Copyright © Elsevier Masson SAS 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hodgins, SAlderton, JCree, AAboud, AMak, TAggressive behaviour, victimization and crime among severely mentally ill patients requiring hospitalisation. Br J Psychiatry 2007; 191: 343–350. http://dx.doi.org/10.1192/bjp.bp.106.06.029587.CrossRefGoogle ScholarPubMed
Tiihonen, JIsohanni, MRäsänen, PKoiranen, MMoring, JSpecific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort. Am J Psychiatry 1997; 154: 840–845.Google ScholarPubMed
Sodhi-Berry, NKnuiman, MAlan, JMorgan, VAPreen, DBPre-sentence mental health service use predicts post-sentence mortality in a population cohort of first-time adult offenders. Soc Psychiatry Psychiatr Epidemiol 2015; 50: 109–124. http://dx.doi.org/10.1007/s00127-014-0919-8.CrossRefGoogle Scholar
Zlodre, JFazel, SAll-cause and external mortality in released prisoners: systematic review and meta-analysis. Am J Public Health 2012; 102:e67–e75. http://dx.doi.org/10.2105/AJPH.2012.300764.CrossRefGoogle ScholarPubMed
Nordentoft, MWahlbeck, KHällgren, JWestman, JÖsby, UAlinaghizadeh, Het al.Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. Plos One 2013;8:e55176. http://dx.doi.org/10.1371/journal.pone.0055176.CrossRefGoogle ScholarPubMed
Wahlbeck, KWestman, JNordentoft, MGissler, MLaursen, TMOutcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry 2011; 199: 453–458. http://dx.doi.org/10.1192/bjp.bp.110.085100.CrossRefGoogle ScholarPubMed
Steingrimsson, SSigurdsson, MIGudmundsdottir, HAspelund, TMagnusson, AMental disorder, imprisonment and reduced life expectancy–A nationwide psychiatric inpatient cohort study. Crim Behav Ment Health 2016; 26: 6–17. http://dx.doi.org/10.1002/cbm.1944.CrossRefGoogle ScholarPubMed
Fazel, SHayes, AJBartellas, KClerici, MTrestman, RMental health of prisoners: prevalence, adverse outcomes, and interventions. Lancet Psychiatry 201610.1016/S2215-0366(16)30142-0CrossRefGoogle ScholarPubMed
Hakansson, ASchlyter, FBerglund, MAssociations between polysubstance use and psychiatric problems in a criminal justice population in Sweden. Drug Alcohol Depend 2011; 118: 5–11. http://dx.doi.org/10.1016/j.drugalcdep.2011.02.014.CrossRefGoogle Scholar
Lappi-Seppälä, TExplaining imprisonment in Europe. Eur J Criminol 2011; 8: 303–328. http://dx.doi.org/10.1177/1477370811411459.CrossRefGoogle Scholar
Clarke, STrends in crime and criminal justice Luxembourg: Eurostat. Report No.: 18; 2013 [Available from: http://ec.europa.eu/eurostat/documents/3433488/5585960/KS-SF-13-018-EN.PDF/b510d657-4749-47f5-81c4-adf66edfa6f3?version=1.0].Google Scholar
Deaths and crude death rate by sex and age 1841-2014. Statistics Iceland n.d. http://px.hagstofa.is/pxenpxen/pxweb/en/Ibuar/Ibuar__Faeddirdanir__danir__danir/MAN05210.px/ (accessed November 27, 2015).Google Scholar
World Health Organisation International statistical classification of diseases and related health problems, 10th ed., World Health Organisation; 2015.Google Scholar
World Health Organisation The ICD-10 Classification of mental and behavioural disorders. Conversion tables between ICD-8, ICD-9 and ICD-10. Revision 1. Geneva, Switzerland; 1994.Google Scholar
Beck, NCDurrett, CStinson, JColeman, JStuve, PMenditto, ATrajectories of seclusion and restraint use at a state psychiatric hospital. Psychiatr Serv 2008; 59: 1027–1032. http://dx.doi.org/10.1176/appi.ps.59.9.1027.CrossRefGoogle Scholar
Delucchi, KLMatzger, HWeisner, CDependent and problem drinking over 5 years: a latent class growth analysis. Drug Alcohol Depend 2004; 74: 235–244. http://dx.doi.org/10.1016/j.drugalcdep.2003.12.014.CrossRefGoogle ScholarPubMed
Vaughn, MGDeLisi, MBeaver, KMHoward, MOMultiple murder and criminal careers: a latent class analysis of multiple homicide offenders. Forensic Sci Int 2009; 183: 67–73. http://dx.doi.org/10.1016/j.forsciint.2008.10.014.CrossRefGoogle ScholarPubMed
Dobson, AJKuulasmaa, KEberle, EScherer, JConfidence intervals for weighted sums of Poisson parameters. Statist Med 1991; 10: 457–462. http://dx.doi.org/10.1002/sim.4780100317.CrossRefGoogle ScholarPubMed
Linzer, DLewis, JpoLCA: An R package for polytomous variable latent class analysis; 2014.Google Scholar
Therneau, TMLumley, T Survival: survival analysis; 2015.Google Scholar
Team RDC, R: a language and environment for statistical computing Vienna, Austria: The R Foundation for Statistical Computing; 2013Google Scholar
Clarke, SCrime and criminal justice statistics, data 2008-2013 Luxembourg: Eurostat - Statistics Explained; 2015 [Available from http://ec.europa.eu/eurostat/statistics-explained/index.php/Archive:Crime_and_criminal_justice_statistics,_data_2008-2013].Google Scholar
Steingrímsson, SSigurdsson, MIAspelund, TSigfússon, SMagnússon, ATotal population-based study of the impact of substance use disorders on the overall survival of psychiatric inpatients. Nord J Psychiatry 2016; 70: 161–166. http://dx.doi.org/10.3109/08039488.2015.1062143.CrossRefGoogle ScholarPubMed
Räsänen, PTiihonen, JIsohanni, MMoring, JKoiranen, MJuvenile mortality, mental disturbances and criminality: a prospective study of the Northern Finland 1966 birth cohort. Acta Psychiatr Scand 1998; 97: 5–9. http://dx.doi.org/10.1111/j.1600-0447.1998.tb09955.x.CrossRefGoogle ScholarPubMed
Harris, ECBarraclough, BExcess mortality of mental disorder. Br J Psychiatry 1998; 173: 11–53. http://dx.doi.org/10.1192/bjp.173.1.11.CrossRefGoogle ScholarPubMed
Politi, PPiccinelli, MKlersy, CMadini, SSegagni Lusignani, GFratti, Cet al.Mortality 5-21 yrs after admission in Italy. Psychol Med 2002;227–237. http://dx.doi.org/10.1017/S0033291701005116.CrossRefGoogle Scholar
Falk, OWallinius, MLundström, SFrisell, TAnckarsäter, HKerekes, NThe 1% of the population accountable for 63% of all violent crime convictions. Soc Psychiatry Psychiatr Epidemiol 2014; 49: 559–571. http://dx.doi.org/10.1007/s00127-013-0783-y.CrossRefGoogle ScholarPubMed
Baillargeon, JBinswanger, IAPenn, JVWilliams, BAMurray, OJPsychiatric disorders and repeat incarcerations: the revolving prison door. Am J Psychiatry 2009; 166: 103–109. http://dx.doi.org/10.1176/appi.ajp.2008.08030416.CrossRefGoogle ScholarPubMed
Kerekes, NLundström, SChang, ZTajnia, AJern, PLichtenstein, Pet al.Oppositional defiant- and conduct disorder-like problems: neurodevelopmental predictors and genetic background in boys and girls, in a nationwide twin study. Peer J 2014;2:e359. http://dx.doi.org/10.7717/peerj.359.CrossRefGoogle Scholar
Ginsberg, YHirvikoski, TLindefors, NAttention Deficit Hyperactivity Disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry 2010;10:112. http://dx.doi.org/10.1186/1471-244X-10-112.CrossRefGoogle ScholarPubMed
Fazel, SWolf, AChang, ZLarsson, HGoodwin, GMLichtenstein, PDepression and violence: a Swedish population study. Lancet Psychiatry 2015; 2: 224–232. http://dx.doi.org/10.1016/S2215-0366(14)00128-X.CrossRefGoogle ScholarPubMed
Miettunen, JSuvisaari, JHaukka, JIsohanni, MUse of register data for psychiatric epidemiology in the Nordic countries. In: Tsuang, MTTohen, MJones, P editors. Textbook of Psychiatric Epidemiology. 3rd ed., Chichester, West Sussex: John Wiley & Sons; 2011. p. 117–131.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.